Incidence of Strabismus Post-Plaque Brachytherapy in Patients With Uveal Melanoma.

PURPOSE: To determine the incidence and type of strabismus in patients with uveal melanoma treated with plaque brachytherapy. DESIGN: Multicenter, retrospective incidence estimation study. METHODS: A total of 438 eyes of 438 patients with uveal melanoma treated with plaque brachytherapy between October 2011 and May 2021. Intervention was Iodine 125, and Palladium 103 plaque brachytherapy. The variables reviewed included incidence of nonresolving strabismus post-plaque brachytherapy, type of strabismus developed, extraocular muscles operated, and modality of treatment received. RESULTS: A total of 438 patients underwent plaque brachytherapy treatment for uveal melanoma. Eleven patients developed strabismus post-plaque brachytherapy (2.5%, n = 11/438). Of these patients, 5 (1.1%, n = 5/438) developed strabismus immediately postoperation. Specifically, 2 patients (0.5%, n = 2/438) developed strabismus immediately postoperation due to slipped muscles, 2 patients (0.5%, n = 2/438) due to decompensated phorias, and 1 patient (0.5%, n = 1/438) due to a fibrotic muscle. Six patients (1.4%, n = 6/438) developed late-onset sensory strabismus. A total of 355 patients (81.1%, n = 355/438) had their extraocular muscles disinserted during surgery, with the lateral rectus being the most common, accounting for 45.4% (n = 161/355), followed by the superior rectus at 26.8% (n = 95/355). Strabismus surgery was the most common treatment modality, comprising 72.7% (n = 8/11) of patients. CONCLUSIONS: The incidence of strabismus after plaque brachytherapy treatment for uveal melanoma was low and primarily classified as late-onset sensory strabismus. Previous studies may underestimate the long-term incidence of strabismus after plaque brachytherapy by focusing primarily on strabismus present immediately postoperatively.

Epidemiology of ocular emergencies in a large Canadian eye centre.

OBJECTIVE: The Eye Institute of Alberta Emergency Eye Clinic (EIA EEC) is a tertiary eye care centre that provides emergency eye services to a population of more than 1 million. The purpose of this study was to describe the epidemiology of ocular emergencies at the EIA EEC. DESIGN: Prospective epidemiologic study based on secondary use of patient data. PARTICIPANTS: All patients seen in the EIA EEC on weekdays between July 2020 and June 2021. METHODS: Charts were reviewed to obtain patient demographics, referral details, final diagnoses, need for imaging, emergency procedures, or further referrals. SPSS Statistics was used for data analysis. RESULTS: A total of 2586 patients were seen over the study period. Most of the referrals (58%) were from emergency physicians. Optometrists and general physicians contributed 14% and 11% of referrals, respectively. Most referral diagnoses were related to inflammation (32%), and trauma (22%). Of all the cases of inflammation, 41% involved infection of the eye and 8% involved infection of ocular adnexa. In addition, 44% and 7% of cases involved noninfectious inflammation of the eye and adnexa, respectively. Frequently preformed emergency procedures were corneal or conjunctival foreign-body removal (39%) and corneal scraping (14%). CONCLUSIONS: Continuing education related to emergency eye care may be most beneficial to emergency physicians, general practitioners, and optometrists. Educational opportunities could focus on most frequently seen diagnostic categories such as inflammation and trauma. Targeted public education aimed at preventing ocular trauma and infection, such as promoting wearing eye protection and practicing contact lens hygiene, may be beneficial.

Outcome measures in childhood glaucoma: a systematic review of randomized controlled trials.

PURPOSE: To synthesize the outcome measures used by randomized controlled trials (RCTs) for childhood glaucoma. METHODS: MEDLINE, EMBASE, and Scopus were searched from inception to February 17, 2023. Randomized controlled trials and observational studies related to childhood glaucoma were included. Primary and secondary outcomes were extracted and the data was used to generate a literature review. RESULTS: This review identified 42 unique reports pertaining to childhood glaucomas. Most of the studies originated from Egypt, India, and the USA. Intraocular pressure (IOP) outcomes were the most frequent outcomes studied, followed by clinical outcomes and safety outcomes. Clinical outcomes were the most common secondary outcomes studied, followed by IOP outcomes and safety outcomes. CONCLUSIONS: This systematic review found heterogenous outcomes with IOP outcomes as the most studied primary outcome. As the remaining outcomes were not consistently utilized, this review highlights the need for a consensus on studies of pediatric glaucoma.

Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

OBJECTIVE: To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion. RESULTS: The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo. CONCLUSION: Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.

Ocular Juvenile Xanthogranuloma With BRAF V600E Mutation in a Child.

The authors present a case of bilateral painless progressive proptosis. A diagnosis of ocular juvenile xanthogranuloma was made based on clinical manifestations, histopathology, and immunohistochemistrical staining. Genetic testing discovered the BRAF V600E mutation. This patient did not respond to standard chemotherapy; however, he demonstrated regression after anti-BRAF targeted therapy. [J Pediatr Ophthalmol Strabismus. 2021;58(4):e19-e21.].

Impact of Systemic Chemotherapy and Delayed Enucleation on Survival of Children with Advanced Intraocular Retinoblastoma.

PURPOSE: Primary enucleation is a well-established method to achieve cure for advanced intraocular retinoblastoma. Recent treatment advances have induced a trend toward trial eye salvage using chemotherapy or other modalities. We investigated how pre-enucleation/postenucleation systemic chemotherapy and the resulting delayed enucleation affect patient survival after failed trial eye salvage. DESIGN: Multicenter, retrospective cohort study. PARTICIPANTS: Children with Group D and E retinoblastoma primarily or secondarily enucleated at 29 Chinese treatment centers. METHODS: Data reviewed included clinical staging, time from diagnosis to enucleation, numbers of cycles of carboplatin, etoposide/teniposide and vincristine chemotherapy, disease-specific survival (DSS), histopathology, and follow-up. MAIN OUTCOME MEASURES: Primary outcome was DSS. Secondary outcome was histopathology of enucleated eyes. RESULTS: Primarily enucleated eyes had significantly shorter delay from diagnosis to enucleation than eyes treated with pre-enucleation chemotherapy (P < 0.001). Delay between diagnosis and enucleation >3.5 months (Group D) and >2 months (Group E) decreased survival (Group D: P = 0.018; Group E: P = 0.017). Compared with primarily enucleated children, children with 1 to 3 cycles of pre-enucleation chemotherapy for Group E eyes had no significant difference in survival (P = 0.74), but those who received ≥4 cycles had worse survival (P = 0.025). After pre-enucleation chemotherapy, more children with Group E (but not Group D) eyes had high-risk histopathology (pT3/pT4) (Group D: P = 0.076; Group E: P < 0.001) and worse survival than those primarily enucleated (P < 0.001). Postenucleation chemotherapy improved survival of children with high-risk histopathology (pT3/pT4) (P = 0.001) but did not change survival of children with low-risk histopathology (pT1/pT2) (P = 0.52). CONCLUSIONS: We observed that pre-enucleation chemotherapy offered no survival benefit and timely enucleation minimized risk of metastatic death. Postenucleation chemotherapy improved survival of children with high-risk histopathology but was not useful for those with low-risk histopathology. These findings facilitate informed discussion on the risks and benefits of delayed enucleation, the use of systemic chemotherapy for trial salvage of eyes with advanced intraocular retinoblastoma, and the specific children who benefit from postenucleation chemotherapy.

Congenital Glaucoma and CHARGE Syndrome: A Case Report.

PURPOSE: To report a rare case of congenital glaucoma in a patient with CHARGE syndrome, present gonioscopic photographs, and explore mechanisms of disease that may account for this association. PATIENTS AND METHODS: We describe a 35-week-old girl with previously diagnosed CHARGE syndrome who presented with corneal edema, buphthalmos, and elevated intraocular pressure in the left eye. She was subsequently diagnosed with congenital glaucoma and started on topical and oral therapy. RESULTS: Examination under anesthesia confirmed the above findings as well as bilateral abnormal angles with an anterior iris insertion at the level of the posterior trabecular meshwork, prominent iris vasculature and stromal strands, and nonvisible scleral spur and ciliary body bands. Trabeculotomy and trabeculectomy were performed in the left eye with a poor outcome. CHARGE syndrome is a complex neurocristopathy, and we propose that the abnormal angle findings and associated asymmetric glaucoma in our patient share a common mechanism of neural crest cell dysfunction. CONCLUSIONS: CHARGE syndrome can be associated with congenital glaucoma and we emphasize the importance of a thorough ophthalmic examination to detect glaucoma with surgical management as deemed appropriate.

Plus Disease: Why is it Important in Retinopathy of Prematurity?

Retinopathy of prematurity (ROP) is one of the leading causes of preventable blindness in childhood. Early posterior pole vascular signs of severe ROP have been studied since the first description of the disease. The progressive changes that take place in the posterior pole vessels of an extremely premature baby occur in a predictable fashion soon after birth. These vascular changes are described as plus disease and are defined as abnormal dilation and tortousity of the blood vessels during ROP that may go on to total retinal detachment. The ophthalmological community now has a better understanding of the pathology and cascade of events taking place in the posterior pole of an eye with active ROP. Despite many years of scientific work on plus disease, there continue to be many challenges in defining the severity and quantification of the vascular changes. It is believed that understanding of the vascular phenomenons in patients with ROP will help in designing new treatment strategies that will help in salvaging many of the eyes with severe ROP.

Acute proptosis in a newborn infant: a presentation of infantile dural fistula.

Rapidly increasing proptosis is rare in a newborn. The causes are diverse, and determining an exact etiology is difficult. We report a case of acute proptosis in a 26 day old infant due to dural fistula. To our knowledge, this is the youngest reported patient with a dural fistula. A multidisciplinary approach was essential to understanding the etiology of the proptosis in this child and providing adequate and successful treatment.

Evaluation of vertical rectus muscles using ultrasound biomicroscopy.

PURPOSE: To evaluate the accuracy of ultrasound biomicroscopy (UBM) in measuring the distance (in mm) from limbus to the insertion of vertical rectus muscles (superior rectus and inferior rectus compared with the "gold standard" surgical caliper at the time of surgery. METHODS: Prospective, masked, observational study of 31 vertical rectus muscle insertions in which we compared the measurements from the limbus as measured by 50 MHz UBM, either preoperatively or at the time of anesthesia, with that measured by surgical caliper intraoperatively. Measurements (UBM and surgical) were evaluated by two different observers and analyzed using the Bland-Altman method. All UBM measurements were done by the same author. The intraclass correlation coefficient (ICC) and Pearson coefficient with 95% confidence intervals were used to quantify the degree of agreement between the two methods. RESULTS: Thirty-one vertical muscles were evaluated (13 superior rectus and 18 inferior rectus, of which 7 muscles were reoperations). The average for UBM measurements was 6.63 mm and for surgical caliper was 7.09 mm. The measurements for the two methods were all within +/-2 standard deviations of the mean. Only three measurements showed differences more than 1 mm. The ICC was 0.78 and Pearson coefficient was 0.85, indicating a "very good" correlation between the two methods. The longest distance from the limbus that could be accurately measured with the UBM was 12 mm. In one case a pseudotendon was differentiated from the true insertion of a previously recessed superior rectus muscle. CONCLUSIONS: The UBM and surgical measurements showed "very good" correlation when allowing for a margin of error of +/-1.0 mm between the two modalities, indicating that the UBM is a good predictor of the position of the vertical rectus muscles.

Factores de ajuste para producción de leche en bovinos Holstein colombiano / Adjustment factors for milk yield in colombian holstein cattle

El objetivo de este trabajo fue estimar factores multiplicativos de ajuste de la producción de leche a 305 días de lactación (PC305) y a edad adulta (PCEA), para rebaños de la raza Holstein colombiano.Fueron utilizadas 116.818 lactaciones de 48.707 vacas, provenientes de los archivos de la Asociación Holstein de Colombia. Los análisis estadísticos fueron realizados mediante la utilización de modeloslineales mixtos usando un modelo animal y el método de máxima verosimilitud restricta (REML). Para producción de leche a 305 días los efectos fijos considerados en el modelo fueron: grupo contemporáneo(rebaño-año), grupo genético de la vaca, mes de parto, número de partos y clases de duración de la lactación en dos grupos de edad de la vaca (<36 y ³ 36 meses) y la covarible edad de la vaca al parto (efecto lineal y cuadrático). Para producción de leche a edad adulta los efectos fijos considerados en el modelo fueron: grupo contemporáneo (rebaño-año), grupo genético de la vaca y clases de edad, número de partos y época de parto. Los efectos aleatorios para las dos variables fueron: efecto genético aditivo, ambiente permanente y residuo. Posteriormente fueron realizados análisis de variancia entre producciones de leche corregidas y no corregidas para determinar la efectividad de la aplicación de losfactores, indicando que la aplicación de los factores de corrección si ajustaron eficientemente producciones de leche para los efectos de duración de la lactación, edad de la vaca, número de partos y época de parto. La mayor producción de leche fue alcanzada por vacas de tres o más partos con edad de 76 a 83 meses de edad y partos ocurridos entre agosto y noviembre.